Ontario inches closer to allowing more doctor support at long-term care homes

Ontario removed a hurdle for doctors making trips to the province’s long-term care homes to diagnose patients for COVID-19 by promising to compensate them as they would at a hospital, shortly after it had shut down multiple proposals from physicians about how it can help prevent the pandemic-caused catastrophe in nursing homes from worsening.

The Ontario Medical Association (OMA) told members in one of its special coronavirus email updates that doctors deployed to test patients for COVID-19 at long-term care homes will now be paid the same amount they would receive for conducting testing at COVID-19 assessment centres. The OMA represents more than 40,000 of the province’s physicians, residents and medical students.

Physicians that charge the government’s fees-per-service have seen their pay disrupted during the pandemic as normal appointments and procedures have been sidelined to prioritize testing and treating COVID-19. Concurrently the Ministry of Health rushed to approve new fee codes that the Ontario Health Insurance Plan (OHIP) hasn’t been able to keep up with paying out. The OMA confirmed on Monday that the Ministry of Health had notified it that doctors could charge the same fees for assessment centre-style testing at nursing homes as they could at hospitals.

The move by the ministry comes just days after it turned down multiple proposals by the OMA to bulk up doctors’ support in long-term care homes, including one pitch by the physicians group to station doctor-led assessment centres at nursing homes.

The province’s Ministry of Health didn’t respond to a request for comment prior to publication.

Dialling up testing for COVID-19 has been identified by health officials at every level of government as an important weapon for the country in it’s fight against the new illness. Dr. Theresa Tam, Canada’s chief public health officer and the leader of the federal response to the coronavirus, tweeted in April that testing for the disease is especially important for tracing the spread of transmission of COVID-19. Tracing allows for faster identification of cases, enabling quicker treatment for those with the illness as well as a better chance of containing the spread, since those who are sick can be isolated from the uninfected.

In Ontario, like the rest of Canada, COVID-19 has spread most viciously in nursing homes, which have become dispersed, miniature epicentres for the deadly disease.

As of Tuesday afternoon, there were 18,310 total confirmed cases of COVID-19 in Ontario. Out of all of the cases in the provinces, more than one-third – 6815 in total – were in patients at nursing homes, according to data collected by Ryerson University’s National Institute on Ageing. Outbreaks have so far affected 289 different nursing homes, but it’s the total number of fatal infections that tell the most devastating story about what the disease has done to the province’s long-term care facilities. Based on Tuesday’s data, more than 80 per cent of the province’s 1,361 fatalities from COVID-19 had been of patients in nursing homes. It’s also taken just 11 days for the number of deaths from the coronavirus to patients in long-term care homes to double.

The federal and provincial governments have identified a number of reasons for why nursing homes have been disproportionately impacted by COVID-19. Residents age and health issues’ are problematic, given that the oldest populations and those with preexisting disorders have, irregardless of country, suffered the worst of the disease. Long-term care homes also typically employ staff that work at multiple facilities, which poses obvious concerns for the cutting of the spread of COVID-19, should a multi-facility staff member get sick.

During negotiations throughout the pandemic with the provincial health ministry, the OMA has pitched several ideas for how to address the fast-escalating severity of the crisis in long-term care, while trying to keep physicians paid properly as many were forced to move away from conducting traditional care.

As well as its proposal to set up mobile, doctor-run COVID-19 assessment centres at nursing homes, the OMA also suggested adding more administrative support for long-term care homes’ medical directors, and expanding virtual palliative care consultation that’s offered to patients in long-term care. Each of the offers were declined when the province put in place its advance payment program for fee-for-service doctors.

A source aware of the negotiations between the Ministry of Health and the OMA, who iPolitics agreed to keep anonymous, said there has been no change on adding help for medical directors or expending nursing homes’ virtual palliative care availability since our publication reported that the proposals had been shut down close to two weeks ago.

“We would like to get back to the table so we can ensure LTC, palliative care and other emerging health issues are resolved before more Ontario patients suffer,” said the OMA’s new president Dr. Samantha Hill, in a statement that was sent by email. Hill succeeded Dr. Sohail Gandhi as president over the weekend. Sunday was the end of Gandhi’s term.